A336 AN UNUSUAL FINDING AT ERCP
Notice bibliographique
Résumé
We present a rare complication during ERCP of portal vein cannulation emphasizing the importance of recognition of this to avoid potentially ominous complications. Our case will be presented below with a review of the literature A 56-year-old male known for dyslipidemia presented to a community hospital with a 3-week history of new postprandial epigastric pain and a 15 pound weight loss. An EGD demonstrated a duodenal mass partially obstructing D1. Biopsies of the mass revealed poorly differentiated adenocarcinoma. A CT abdomen showed eccentric thickening of the gastric antrum with aneurysmal dilation and abnormal appearance of D1 and D2. Abnormal tissue was described at the head of pancreas making it difficult to identify the origin of the mass. MRCP showed eccentric D1 and D2 thickening highly suggestive of a primary duodenal neoplasm (7.3x5.0x4.6cm). The mass did not appear to arise from the pancreas. Two additional masses, thought to be possible metastatic lymphadenopathy were described. The patient was transferred to a tertiary care center. While admitted there an elevated cholestatic liver enzyme pattern was noted to be worsened with no signs or symptoms of cholangitis. ERCP was arranged for suspected biliary obstruction prior to planned chemotherapy. During the ERCP the duodenal mass was easily traversed. The papilla had a normal appearance. Cannulation with sphincterotome and guidewire was performed. Contrast was injected however the biliary tree did not appear to opacify. Despite injecting significant amounts of contrast, it appeared as if the contrast was dispersing rapidly. Multiple fluoroscopic images were taken while adjusting the views as this was very atypical. It became apparent that the portal vein had been cannulated and the contrast was flowing through the portal vein. The procedure was aborted. No immediate complication occurred as a consequence of the PV cannulation during the ERCP. A percutaneous biliary drain was inserted the same day. Portal vein cannulation or opacification of the portal venous system during ERCP is an exceedingly rare complication with a reported incidence of less than 1/6000 [1]. The majority of cases reported in the literature have been in the context of pancreatic cancer and after sphincterotomy [2–5]. One portobiliary fistula was described pre-procedure [6]. Two cases have been reported in non-pancreatic cancer cases with standard wire guided cannulation technique [7, 8]. Although many complications including bleeding, sepsis and portal thrombosis are possible none of the reported cases have described any complications. Similarly, in our case no immediate post procedure complication arose. However, had stenting been undertaken the consequences would likely have been more detrimental. This exceptionally infrequent complication is therefore important to recognize promptly during ERCP, which should then be terminated immediately. NoneNone
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,006 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,002 |
| Bibliométrie | 0,004 | 0,003 |
| Études des sciences et des technologies | 0,002 | 0,001 |
| Communication savante | 0,003 | 0,003 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,007 | 0,004 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,007 | 0,006 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».